Cognitive etiologies of bulimia nervosa (and studies)

Travis DixonAbnormal Psychology

One of the main symptoms of bulimia nervosa is binge eating followed by some form of purging. Body dissatisfaction could be one contributing etiology of these symptoms.


Potential risk factors for the development of bulimia nervosa (BN) include those related to thought patterns (i.e. cognition) like body dissatisfaction, idealization of thinness, distorted body images and what people perceive others to prefer in terms of body weight and shape. These thought patterns could then lead to behaviours that could lead to the development of BN, like dieting or restricted eating. Which, in turn, could lead to bingeing and purging.

When analysing cognitive etiologies, it’s imperative that one continually asks the questions, ‘what could be influencing the development of these thought patterns?’ And ‘how could these thoughts lead to BN symptoms?’ That is to say, if an individual has an idealization of thinness, it’s important to consider how this may have developed. Similarly, if someone is dissatisfied with their body, how could this influence their behaviour? 

Linking the factors with the symptoms is the key in explaining etiologies of disorders.

Original Study Outline

Rozin and Fallon conducted one study in 1985 that compared US male and female college students and measured their body dissatisfaction. Using body silhouettes (fig. 1), they were asked to identify:

  • their ideal figure
  • their current figurse
  • what they thought the opposite sex thought was the most attractive.

Body dissatisfaction can be measured by analysing the difference between the “ideal” and “current” ratings, as well as between what the opposite sex found attractive and the “current” figure.


Fig 1. This is the type of image researchers use to study perceptions of body shapes and body dissatisfaction.

The results of this study showed that males chose similar silhouettes for all three. The females, however, selected “current” body shape silhouettes that were heavier than their ideal and were heavier than what they thought men would want.

Replicated Research (Methods and Results)

In a follow-up study, published in 1988, Rozin and Fallon used similar methodology, but this time they included data from their student participants’ parents. Students were recruited from first year university courses.In order for the data to be included, the son/daughter (college aged participant) had to have both biological parents alive and still living together and had to have spent most of their pre-college years living with both parents.

Possible details for evaluation: 97 families participated in the follow-up study; there were 55 daughters, and 42 sons. (94% of the participants were white and 6% were “other”. A majority (60%) of the families were Jewish and about 35% were Christian.)  

The participants were given the same silhouettes in a questionnaire as in the previous research (fig. 1). Additional data regarding weight and eating were also collected using the questionnaire. For example, frequency of concerns about weight, feeling guilty about eating, holding back at meals and dieting were measured by asking participants to select one of the following options:

  1. never
  2. rarely
  3. sometimes
  4. often
  5. almost always.

The results from the sons and daughters were very similar to the previous research study (1985) – in general, women were more dissatisfied than men with their body image. The sons showed almost no difference, on average, between their ideal and their current weight. Fathers, mothers and daughters all showed a notable disparity between their current figure and their ideal figure.

The researchers then analysed the responses to how these groups thought about this disapirty between their current figure and their ideal. The results of the questionaires showed that mothers and daugthers often reported concern about their weight, whereas most fathers and sons did not. Fathers also did not “hold back” during meals and dieted less. Furthermore, fathers seemed to recognize that they were overweight but did not seem to change their attitudes or behaviours because of this. The researchers concluded that although fathers were dissatisfied with their current body shape, this did not lead to discomfort or concern, whereas it did in the female participants (i.e. mothers and daughters).

Additional Research – What women think women want (Cohn and Adler, 1992)

An interesting replication of this research added an additional question to the silhouette questionnaire. They asked college aged males and females to not only identify the same figures as the previous research (i.e. ideal, current, opposite gender’s ideal), but they also asked to identify what they thought members of their same gender thought was the ideal. For instance, men were asked to identify what they thought other men viewed as the ideal for a male. The results of this research reflect prior studies in that the females believed the male’s ideal was thinner than their current weight. Interestingly, the females selected “Peer Ideals” as less than what they actually believed was their ideal weight. The men on the other hand, selected Peer Ideals as being larger than what they themselves believed to be the ideal.

Critical Thinking Questions


  • How can these research studies be used to support possible cognitive explanations of the development of symptoms of bulimia nervosa? (Application/Analysis)
  • How does the final research study suggest different body ideals may be the result of perceived peer pressure? (Application/Analysis)
  • What possible biological and/or sociocultural factors could be influencing the gender differences found in body dissatisfaction? (Synthesis)
  • What are the strengths and limitations of these studies? (Evaluation)



Fallon, April. Rozin, Paul. Body Image, Attitudes to Weight, and Misperceptions of Figure Preferences of the Opposite Sex: A Comparison of Men and Women in Two Generations. Journal of Abnormal Psychology. 1988, Vol.97, No. 3. 342-5. Accessed from <>

Adler, Nancy E. Cohn, Lawrence D. Female and male perceptions of ideal body shapes: Distorted views among Caucasian college students. Psychology of Women Quarterly, 16. 1992. 69-79.